Laura Ernande1, Etienne Audureau2, Christine L Jellis3, Cyrille Bergerot4, Corneliu Henegar5, Daigo Sawaki5, Gabor Czibik5, Chiara Volpi6, Florence Canoui-Poitrine2, Hélène Thibault7, Julien Ternacle1, Philippe Moulin8, Thomas H Marwick9, Geneviève Derumeaux10. 1. Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France. 2. Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; CEpiA EA7376, DHU Ageing-Thorax-Vessel-Blood, Université Paris Est (UPEC), Créteil, France. 3. Cardiology Department, Cleveland Clinic, Cleveland, Ohio. 4. Centre d'Investigation Clinique INSERM 1407 Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France. 5. INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France. 6. Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France. 7. Service d'Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France; INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon, Lyon, France. 8. INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon, Lyon, France; Fédération d'endocrinologie, Hospices Civils de Lyon, Bron, France. 9. Baker Heart and Diabetes Institute, Melbourne, Australia. 10. Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France. Electronic address: gderumeaux@gmail.com.
Abstract
BACKGROUND: Type 2 diabetes mellitus (T2DM) may alter cardiac structure and function, but obesity, hypertension (HTN), or aging can induce similar abnormalities. OBJECTIVES: This study sought to link cardiac phenotypes in T2DM patients with clinical profiles and outcomes using cluster analysis. METHODS: Baseline echocardiography and a composite endpoint (cardiovascular mortality and hospitalization) were evaluated in 842 T2DM patients from 2 prospective cohorts. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed. RESULTS: Three clusters were identified. Cluster 1 patients had the lowest left ventricular (LV) mass index and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') ratio, had the highest left ventricular ejection fraction (LVEF), and were predominantly male with the lowest rate of obesity or HTN. Cluster 2 patients had the highest strain and highest E/e' ratio, were the oldest, were predominantly female, and had the lowest rate of isolated T2DM (without HTN or obesity). Cluster 3 patients had the highest LV mass index and volumes and the lowest LVEF and strain, were predominantly male, and shared similar age and rate of obesity and HTN as cluster 1 patients. After follow-up of 67 months (interquartile range: 40 to 87), the composite endpoint occurred in 56 of 521 patients (10.8%). Clusters 2 (hazard ratio: 2.37; 95% confidence interval: 1.15 to 4.88) and 3 (hazard ratio: 2.19; 95% confidence interval: 1.00 to 4.82) had a similar outcome, which was worse than cluster 1. CONCLUSIONS: Cluster analysis of echocardiographic variables identified 3 different echocardiographic phenotypes of T2DM patients that were associated with distinct clinical profiles and highlighted the prognostic value of LV remodeling and subclinical dysfunction.
BACKGROUND:Type 2 diabetes mellitus (T2DM) may alter cardiac structure and function, but obesity, hypertension (HTN), or aging can induce similar abnormalities. OBJECTIVES: This study sought to link cardiac phenotypes in T2DM patients with clinical profiles and outcomes using cluster analysis. METHODS: Baseline echocardiography and a composite endpoint (cardiovascular mortality and hospitalization) were evaluated in 842 T2DM patients from 2 prospective cohorts. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed. RESULTS: Three clusters were identified. Cluster 1 patients had the lowest left ventricular (LV) mass index and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') ratio, had the highest left ventricular ejection fraction (LVEF), and were predominantly male with the lowest rate of obesity or HTN. Cluster 2 patients had the highest strain and highest E/e' ratio, were the oldest, were predominantly female, and had the lowest rate of isolated T2DM (without HTN or obesity). Cluster 3 patients had the highest LV mass index and volumes and the lowest LVEF and strain, were predominantly male, and shared similar age and rate of obesity and HTN as cluster 1 patients. After follow-up of 67 months (interquartile range: 40 to 87), the composite endpoint occurred in 56 of 521 patients (10.8%). Clusters 2 (hazard ratio: 2.37; 95% confidence interval: 1.15 to 4.88) and 3 (hazard ratio: 2.19; 95% confidence interval: 1.00 to 4.82) had a similar outcome, which was worse than cluster 1. CONCLUSIONS: Cluster analysis of echocardiographic variables identified 3 different echocardiographic phenotypes of T2DM patients that were associated with distinct clinical profiles and highlighted the prognostic value of LV remodeling and subclinical dysfunction.
Authors: Damini Dey; Piotr J Slomka; Paul Leeson; Dorin Comaniciu; Sirish Shrestha; Partho P Sengupta; Thomas H Marwick Journal: J Am Coll Cardiol Date: 2019-03-26 Impact factor: 24.094
Authors: Dryden R Baumfalk; Alexander B Opoku-Acheampong; Jacob T Caldwell; Alec L E Butenas; Andrew G Horn; Olivia N Kunkel; Steven W Copp; Carl J Ade; Timothy I Musch; Bradley J Behnke Journal: Am J Transl Res Date: 2021-01-15 Impact factor: 4.060
Authors: Giacomo Zoppini; Corinna Bergamini; Stefano Bonapace; Maddalena Trombetta; Alessandro Mantovani; Anna Toffalini; Laura Lanzoni; Lorenzo Bertolini; Luciano Zenari; Enzo Bonora; Giovanni Targher; Andrea Rossi Journal: BMJ Open Diabetes Res Care Date: 2018-06-14